Friday, June 3, 2016

Colleague Question #1: ASD client swallows pool water. What do I do?

Often times, I will receive questions from colleagues via email or FB private messages regarding specific cases they are dealing with.  I tend to shoot back an email but I have been thinking lately that it might help to share these responses with you too.  Maybe they will help or maybe they will spurn a few additional great ideas from you that you can share with your fellow colleagues.  So here is the first post in this "Colleague Question" series.

A fellow colleague writes:

"I have a client with ASD and SPD...he loves swimming but can't stop swallowing the pool water. He also struggles with swallowing instead of spitting during teeth brushing.  His parents have suspended his swimming lessons even though he so enjoys them because he can become ill from all the water he takes in...Any suggestions?"

Some of you reading this question may be asking yourselves "What does this have to do with speech therapy or communication?", yet, the reality is, as SLPs, we may be the only service provider for some children and therefore, the only source of guidance and education for parents.  It's important for us to fully understand sensory needs in our ASD population and how we can assist parents in providing effectively for those needs.

For this particular case, let me first say that it is important to keep safety at the forefront of decision making for our clients so I can understand why the child's parents would suspend swimming lessons at this time. However, for children who have sensory needs it is almost painful for me to hear a child not being able to participate in such an enjoyed activity.  I'm sure swimming provides some wonderful sensory input as well as a wonderful social opportunity for this child and my hope would be to find a way to get this child back to swimming lessons as soon as possible.  As this is a safety issue, we cannot encourage this behavior even if it provides some sensory feedback for the child.  What I would suggest is possibly finding a way to appropriately replace this behavior with something safer that the child can do in the water while still providing some type of sensory input.

An acceptable compromise would be to try and replace drinking the pool water with blowing bubbles with lip trill (sounding like a "motor boat") or humming with child's lips sealed while in the water (nose and eyes above water).   Either of these options will still provide sensory input to the child's face but will encourage water to be blown away from lips, or in the case of "humming", total lip closure.  These activities can be practiced at home during bath time so that the child can master one or both of these replacement behaviors initially, then transferred to practicing them in the pool during non-lesson times first, following by adding them during swimming lessons.

To aid in decreasing swallowing of saliva during teeth brushing, it might help child to have a visual goal to encourage a replacement behavior.  Possibly parents can teach the child to spit often (every few brush strokes) into a small disposable bathroom cup.  They could make a game out of it by brushing their teeth together with the child, modeling how to brush and spit often.  Parents and child can each have their own cup in which they draw a large line on the outside of cup indicating a stopping point.  Whomever fills up the cup to that line first wins the game.  This encourages spitting often while making this activity, hopefully a bit reinforcing, creating excitement and fun!  Of course it doesn't sound very appealing to be spitting into a cup and having to look at it for us as adults, but the visual may provide the child with a concrete goal so that he can learn how to spit rather than swallow during teeth brushing.  Over time this activity can be modified to see who can spit in the sink a certain number of times, and so on, so that the cup gets faded out and typical teeth brushing remains.

I hope these suggestions help.  Have any suggestions of your own you'd like to add?  Feel free to comment below.

Look for more posts in this new series to come over the next few weeks.  If you have a specific question you'd like answered feel free to email me at  You just might see your question pop up in this series.  (Note: all identifiable information will remain confidential.)

Happy talking and swimming this summer!
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